Eating disorders Flashcards
What is bulimia nervosa?
An eating disorder in which there are periods of binge eating followed by compensatory weight loss behaviours ie. induced vomiting, fasting, intense exercise, medication abuse (laxatives, thyroxine etc)
Feature of a patient with bulimia nervosa?
Obsessed with body shape and weight
Weight is overly important on self evaluation
Feel like they can’t control their eating
Post-binge techniques to compensate for binge (induced vomiting, fasting, intense exercise, medication abuse (laxatives, thyroxine etc))
More common in which sex?
Females - 10:1
2% lifetime prevalence in females
Physical symptoms of bulimia nervosa
Bloating/fullness Lethargy Heartburn/reflux Abdominal pain Sore throat, dental problems (from vomiting)
Severe signs of bulimia nervosa
- Swollen salivary (parotid) glands
- If diuretic/laxative abuse - oedema
- If inducing vomiting - Russel’s sign (calluses form on back of hands from hand scraping against teeth when trying to induce vomiting)
- Erosion of dental enamel due to repeated vomiting
What you’re looking for on examination (as well as the severe signs) - for bulimia nervosa
Dehydration
Arrhythmias (from hypokalaemia)
BMI - take weight and height
Blood pressure
Investigations - U&Es - K, renal function
Management of bulimia nervosa
First line - self help program for BN (family therapy if under 18)
second line - CBT-ED - eating disorder focused CBT
Refer to specialist eating disorder service Manage suicide risk Manage low potassium Check fluids/U&Es regularly Dentist visits
Complications of bulimia nervosa
Haematemesis
Hypokalaemia
dental erosions
anorexia nervosa
Anorexia nervosa - overview
Maintain a low body weight, obsessed with being thin or not being fat. They believe that they are fat already so dont want to put more weight on.
Low body weight rapid weight loss weight loss measures (extreme dieting) psychological features (distorted body image) fear of gaining weight
Clinical features of anorexia nervosa
Low BMI
Restrictive dieting
Distorted view of body, denial of a problem
Over exercise etc to lose more weight
Amenorrhoea 3+ months
GI symptoms - constipation, bloated after food, dysphagia, abdominal pain
Fatigue, fainting, dizzy, cold intolerance
Muscle loss (inc. diaphragm and HEART (HR,BP etc!)
Bone marrow bad, less WBC, RBC, platelets
Brittle hair on head, soft on skin (lanugo)
Examination findings in anorexia nervosa
U&Es, ECG, DEXA scan
low BMI (below 13 - high risk)
Low HR (under 40 - high risk)
Low temperature (under 35 risk)
Hypotension (under 90/70, postural drop >10)
Peripheral oedema (heart weak and low protein)
Proximal muscle weakness (squat test (not using arms))
Osteoporosis on DEXA scan
Management of anorexia nervosa
In under 18s - AN-FT - anoroxia nervosa focused family therapy
ED-CBT(Individual eating-disorder-focused cognitive behavioural therapy)
[Also Maudsley Anorexia Nervosa Treatment for Adults (MANTRA and Specialist supportive clinical management (SSCM)]
Bulimia vs anorexia - if they are purging and under weight what are they?
Anorexia. These patients can still eat lots and purge like bulimia but they are underweight. Bulimic patients are normal or overweight
Refeeding syndrome - what happens if starving people eat loads
Insulin secretion causes cells to take in already low levels of K, Mg, PO4 - risk of arrhythmias
Psychological symptoms of anorexia nervosa
Low self esteem Lonely Sensitive to criticism Need approval Over react Perfectionism
Binge eating disorder - overview
regularly eating large portions of food all at once until you feel uncomfortably full, and then often upset or guilty.
eat even when full, not hungry, and eating fast
feel out of control during these episodes
treatment - self help + CBT
Other specified feeding or eating disorder (OSFED) - overview
These are eating disorders that don’t tick all the boxes needed to make a diagnosis such as anorexia, bulimia or binge eating disorder.
Starvation - what happens metabolically
Normally body uses glucose as energy. Glucagon releases this from the glycogen stores which replenish after meals.
Starvation response begins when glycogen stores are depleted
Fatty acids become main energy source (brain continues with glucose) - first 2-3 days
Next ketone bodies (from fatty acids) are used for energy by brain (2-3days)
Next proteins are broken down into glucose etc - these come mostly from muscle in the body - hence the muscle wasting seen in starvation
ketoacidosis can occur - metabolic acidosis
so glucose should be given IV slowly…
Why does brain suffer if starving? Why do you get cognitive impairment?
Only 75% of brains energy requirement can be provided via ketone bodies so there is a deficit and impairment
What is Münchhausen’s Syndrome
- Simulated illness: either physical or psychiatric. (can contaminate samples to look pathological)
- Pathological lying (pseudologia fantastica).
- Wandering from place to place (peregrination): the patient typically presents to numerous different hospitals, using different names.
May self inflict disease - ie eating contaminated food to induce food poisoning
